Abstract
BACKGROUND: Paravertebral block (PVB) is commonly used for analgesia postoperatively while rarely as anesthesia during surgical stabilization for rib fractures. This study aimed to explore the feasibility and safety of PVB analgesia alone during surgical stabilization for patients with multiple rib fractures (MRF) under conscious state. METHODS: This prospective single-arm pilot study was conducted in patients with MRF who schedule for surgical stabilization using PVB analgesia in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between September 2019 and September 2020. The outcomes were the vital signs, postoperative pain and nausea and vomiting (PONV). Those who underwent general anesthesia (GA) during the same period were included for post hoc analysis. RESULTS: Eighteen patients (aged 62 ± 10.64 years; 8 males) were enrolled. The vital signs, including SpO(2), systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, of the patients at baseline, perioperative, intraoperative, and postoperative day 1 were kept normal. The postoperative numerical rating scale (NRS) pain scores at 6, 12, and 24 h were 2.67 ± 1.36, 2.44 ± 0.80, and 2.33 ± 0.86, respectively, which were improved compared with baseline (5.78 ± 1.00). No PONV, postoperative morbidity, pulmonary infections, or incision infections were observed. Additionally, post-hoc analysis for the comparison of patients who underwent GA with PVB (in the pilot study) showed a similar number of rib fracture fixation (P = 0.06) and analgesic effect (P = 0.06) after operation, while a significantly shorter total length of hospital stay (P < 0.01), postoperative hospital stay (P < 0.01), lower dose of sufentanil citrate use (P < 0.01),and total costs(P < 0.03)in patients who underwent PVB. CONCLUSIONS: PVB analgesia during surgical stabilization for MRF under a conscious state might be feasible and safe. Compared with GA, PVB analgesia might reduce the dose of narcotics, shorten the length of hospital stay, and reduce the cost of hospitalization. CLINICAL REGISTRATION: www. CLINICALTRIALS: gov (#NCT04536311).